Bronchobiliary fistula in fibrolamellar hepatocellular carcinoma with anesthetic challenges during living donor liver transplantation: A case report

Table 3 Comparative review of anesthetic strategies in literatures

	Sex/age	Primary disease	Biloptysis	Fistula affected lung	Pre-existing pulmonary disease	Surgery	Surgical position	Anesthesia	Endotracheal tube	Ventilation mode	Anesthetic challenge
1	Male/44	BBF after pancreaticoduodenectomy	Yes	Right	Pneumonia	Resection of fistula and bilobectomy	Left lateral decubitus position	GA	Left-sided DLT	OLV	Initially saturation decreased but gradually increased. Repeated bronchial lavage
2	Female/64	BBF with thrombosed hepatic artery aneurysm	Yes	Right	No	Deceased donor liver retransplantation	Supine position	GA	37-Fr left-sided DLT	OLV with CPAP in the right lung	After skin closure, approximately 500 mL/minute air leak from a suspected residual right bronchopleural fistula was detected during TLV, so OLV was resumed
3	Male/58	BBF with prior hepatic hydatid cyst resection	Yes	Right	No	Thoracotomy and resection of fistula and lobectomy	Left lateral decubitus position	GA	37-Fr left-sided DLT	OLV	-
4	Male/61	Intrahepatic cholangiocarcinoma	Yes	N/A	No	ERCP	N/A	GA	8.0 mm SLT	TLV	A spontaneous bronchobiliary fistula to the right bronchial tree was identified intraoperatively, and the patient was reintubated with a DLT
5	Male/20	BBF with prior exploratory laparotomy for grade 4 liver injury due to a blunt abdominal trauma	Yes	Right	No	ERCP and placement of a biliary stent	Prone and slight head-up position	MAC	N/A	SV	Temporarily hypotensive initially and thereafter remained hemodynamically stable
6	Male/66	Polycystic kidney disease and ESLD	Yes	NA	No	Combined liver-kidney transplantation	Supine position	GA	SLT and using a fogarty catheter	TLV	Identified intraoperative BBF with significant air leak; selective segmental isolation using a fogarty catheter

BBF: Bronchobiliary fistula; ESLD: End-stage liver disease; ERCP: Endoscopic retrograde cholangiopancreatography; GA: General anesthesia; MAC: Monitored anesthesia care; N/A: Not applicable; DLT: Double-lumen tube; SLT: Single-lumen tube; OLV: One-lung ventilation; CPAP: Continuous positive airway pressure; SV: Spontaneous ventilation.